Skip to main content

This job has expired

Telephonic Nurse Case Manager

Employer
ICW Group
Location
San Diego, California
Salary
Not Specified
Closing date
Jun 8, 2019

View more

Category
Health and Medical
Job Type
Not Specified
Career Level
Not Specified

Job Details

ICW Group Insurance Companies is recognized nationally as an insurance leader in helping policyholders achieve fewer and less costly claims in both Property & Workers' Compensation. We have an exciting opportunity as a Telephonic Nurse Case Manager. The purpose of this job is to perform clinical assessment and evaluate needs for treatment in workers compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risk on behalf of the Company.

About your job:

Creates and manage workers compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

  • Performs initial and ongoing clinical assessments via telephone calls to the injured worker, employer physician and attorney
  • Assesses client situation for psychosocial needs, cultural implications and ensures support systems in place
  • Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria
  • Monitors ongoing progress toward established goals and objectives
  • Implements plan through case management interventions and communication with all parties desired to reach desired goals and objectives

Measures effectiveness of treatment plans and creates alternate strategies when needed.

  • Recommends need for alternative treatment plans using systematic and objective procedures set by the Company
  • Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards
  • Negotiates and coordinates a prompt return to work with employer
  • Measures and reports on interventions to determine the outcome of the case managers involvement to include clinical, financial, variance, quality of life, and client satisfaction
  • Maintains accurate record of management including costs, savings and demographic data

Communicates effectively with all parties involved in injured workers treatment.

  • Provides case direction to field case specialists when on-site intervention is required; ensured quality and appropriate service deliver
  • Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case
  • Maintains injured workers privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards
  • Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
  • Performs Utilization Review activities and reviews timely reports with clients and providers.

Supervisory Responsibilities:

None.

Education and Experience:

Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) and 1+ year of professional experience providing direct clinical care required. Bachelors degree (B.A. or B.S.) from four-year college or university in nursing (BSN) preferred. Equivalent combination of education and experience may be considered.

Certificates, Licenses, Registrations:

Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.

Knowledge and Skills:

Ability to work with medical and mathematical concepts such as diagnoses, probability and statistical inference. Ability to compute mathematical frequency and percentages. Ability to apply principles of logical, sounds judgement or medical thinking to a wide range of intellectual and practical problems. Ability to combine disparate skills and thinking to craft solutions to moderate to complex problems. Ability to hypothesize on root cause of inefficiencies in treatment and then articulate probable solutions. Ability to read, analyze, and interpret documents such as medical reports and health information of all types, industry journals, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, injured workers and members of the business community. Must be able to read, write and speak English effectively. Ability to effectively present information to ICW staff, and external audiences.

Physical Requirements:

While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision. The worker is required to have visual acuity and be capable of operating and viewing computers and other electronic devices for extended periods of time.

Work Environment:

The noise level is usually quiet in the work area with moderate noise in the computer room.

Occasional travel may be required.

Company

 

ICW Header

 

Headquartered in San Diego, ICW Group is a multi-line insurer that provides coverage solutions to businesses through a network of independent agents and brokers. ICW Group offers three types of insurance—workers' compensation, earthquake and auto insurance. Known for meeting the needs of its policyholders, ICW Group prides itself on providing service that is truly customer-centric. In recent years, ICW Group has earned a reputation for helping policyholders achieve fewer and less costly claims. The company accomplishes this through extensive risk management expertise, highly proactive claims handling, and aggressive fraud monitoring.

At ICW Group, our focus and passion is offering great insurance products, services and experiences. We honor our commitments to our customers, our communities and each other to ensure that you have a better today and a safer tomorrow. With our home office in sunny San Diego, CA and with 10 branches across the U.S., ICW Group has over 40 years of experience in property and casualty insurance. Our passionate and creative team members are the power behind our successful business. 

A strategic investment in innovation today is critical to our success in the future. Our leaders welcome people who are eager to bring the power of innovation, the willingness to try something different or adopt a new approach or technology as we evolve to meet the needs of our customers and agents. Our culture fosters experimentation in models, processes, and products in an effort to move forward and help shape not only ICW Group’s future but the insurance marketplace as a whole. 

ICW Group is committed to the satisfaction of our customers and recognizes that satisfied, contributing Team Members are the foundation of a superior customer experience. With a team of 880, our enterprise is sized just right to provide broad challenging job responsibilities in a more personal environment. An important part of this personal approach to your success is our commitment to health and wellness. We provide a comprehensive program to help you maintain your total health because we believe that being at your personal and professional best is important to you and your family. 

Company info
Website

Get job alerts

Create a job alert and receive personalized job recommendations straight to your inbox.

Create alert